High Triglycerides: Essential Information

Cardiac Sciences

High Triglycerides: Essential Information

Triglycerides are a type of fat commonly known as lipids. They circulate in one's blood, and their major source is diet. Another source is the unused calories, which are stored as triglycerides in fat cells. Hypertriglyceridemia is a blood lipid disorder characterized by high blood levels of triglycerides. This disease can occur on its own; with other lipid disorders, like high blood cholesterol or low HDL cholesterol; or even due to some health conditions, medicines, genes, and lifestyle habits. All these can lead to a series of complications, including high blood pressure, diabetes, and vascular complications, such as coronary artery disease, etc. This can be managed by making significant lifestyle changes, like regular exercise, dietary changes, and managing stress levels, and medically (by statins, fish-oil capsules, etc.).

Global Burden of Hypertriglyceridemia

The global prevalence of hypertriglyceridemia varies by age, sex, and other factors. 29.6% of the global population has hypertriglyceridemia, with prevalences of 36.9% and 23.8% in men and women, respectively. This condition is more common in men aged above 30 and women aged above 60.

Hypertriglyceridemia is more prevalent in people with certain comorbidities, such as hypertension (61% of men and 51.4% of women with hypertension), diabetes (68.2% of men and 73.8% of women with diabetes), obesity (21.7% to 24.6%), alcohol consumption (27.4%), hypothyroidism (10.15%), etc.

Causes and Risk Factors

Hypertriglyceridemia is a coalition of a series of causes and risk factors, including:

• Health Challenges

Health conditions like obesity, type 2 diabetes mellitus, kidney diseases, hypothyroidism, liver diseases, and pancreatitis can increase the risk of hypertriglyceridemia.

1. Obesity

Increased body fat, in particular visceral fat, increases the production of triglycerides and reduces its clearance from the blood.

1. Type 2 diabetes mellitus

The inability of the body to utilize glucose leads to elevated blood sugar levels, triggering the liver to produce more triglycerides.

1. Kidney diseases

Chronic kidney disease (CKD) can impair the clearance of triglycerides due to altered lipoprotein metabolism. In addition, protein loss in urine can lead to inflammation and exaggerate the condition.

1. Hypothyroidism

Low thyroid hormone levels can reduce the activities of enzymes involved in lipid metabolism, leading to reduced clearance of triglycerides.

1. Liver diseases

Impairment of the liver's ability to process fats can lead to the accumulation of triglycerides in the liver and bloodstream.

1. Pancreatitis

Pancreatitis can lead to impaired lipid metabolism, further increasing blood triglyceride levels.

• Lifestyle Challenges

Unhealthy lifestyle practices - high carbohydrate intake, high saturated and trans-fat intake, excessive alcohol consumption, sedentary lifestyle, smoking, and irregular eating and sleeping habits - can precipitate hypertriglyceridemia.

• Genetics

Inherited conditions, like familial hypertriglyceridemia, and alterations in the expressions of genes, such as LPL, ApoC2, ApoC3, and Angptl3, can lead to hypertriglyceridemia.

Presentation and Diagnosis

Symptoms of hypertriglyceridemia are usually not evident until blood triglyceride levels surpass 1000-2000 mg/dL. Symptoms include:

1. Gastrointestinal: Mild epigastric pain, including pain in other regions like the chest or back. Sometimes nausea/vomiting or dyspnea might also occur
2. Dermatologic: Severe cases may lead to the occurrence of skin lesions called xanthomas
3. Ophthalmologic: Greyish-white opacification at the periphery of the cornea or pale-yellow raised lesions around the eyelids

Blood triglyceride level is the hallmark diagnostic test for hypertriglyceridemia. The ranges are as follows:

Normal Levels

<150 mg/dL

Moderate Hypertriglyceridemia

150-1000 mg/dL

Severe Hypertriglyceridemia

>1000 mg/dL

Complications of Hypertriglyceridemia

Key complications associated with hypertriglyceridemia include:

1. Cardiovascular diseases
2. Fatty liver disease (Hepatic Steatosis)
3. Diabetes mellitus
4. Pancreatitis
5. Xanthomas
6. Retinopathy

• Cardiovascular Diseases: Cardiovascular diseases are the key complications of hypertriglyceridemia. Patients diagnosed with hypertriglyceridemia are more prone to coronary artery diseases, heart attacks, and stroke due to the hardening of arteries (atherosclerosis).
• Hepatic Steatosis: Fat accumulation in the liver can lead to non-alcoholic fatty liver disease (NAFLD), which can progress over time to more severe conditions, such as non-alcoholic steatohepatitis, fibrosis, cirrhosis, and even liver carcinoma.
• Diabetes Mellitus: Hypertriglyceridemia is associated with insulin resistance, which, in turn, can lead to type 2 diabetes mellitus.
• Pancreatitis: Severe hypertriglyceridemia can lead to inflammation in the pancreas, causing pancreatitis. Recurrent acute episodes of pancreatitis can lead to long-term damage to the pancreas, causing chronic pancreatitis.
• Xanthomas: Hypertriglyceridemia can lead to fatty deposits under the skin called xanthomas. These xanthomas appear as yellowish nodules and are more common in elbows, knees, hands, etc.
• Retinopathy: Extremely elevated blood triglyceride levels can lead to creamy white opacity of retinal blood vessels that can cause impaired vision.

Management of Hypertriglyceridemia

Hypertriglyceridemia can be effectively managed by the synergistic combination of adopting healthy lifestyle changes and medications. Some of the effective strategies include:

• Dietary changes:
  • Reduction in carbohydrates and added sugars
  • Reduction in total fat intake
  • Halting alcohol consumption
  • Increase in fiber content
  • Taking food rich in omega-3-fatty acids
• Physical activity and weight loss:
  • Engaging in at least 1.5 hours of daily workout of moderate-intensity aerobic exercises can cause a significant reduction in triglyceride levels.
  • Losing weight, particularly if obese, can also significantly reduce triglyceride levels.
• Medications
  • Medical management includes fibrates, omega-3 fatty acids, statins, niacin, and ezetimibe.
• Management of risk factors:
  • Regular monitoring of blood pressure and management is essential to reduce overall cardiovascular risk.
  • Smoking/alcohol cessation is crucial for the reduction of cardiovascular risk.

Conclusion

High triglyceride level is a silent killer for individuals suffering from various health conditions, in particular cardiovascular illnesses. Adopting a healthy lifestyle and proper medical management can keep triglyceride levels under check and reduce the risk of complications. Timely clinical visits and keeping regular health check-ups can prevent severe and long-term complications.

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